MedicaidPrior AuthHigh impact
Frenectomy and Frenotomy Procedures Require Prior Authorization, Effective January 1, 2026
Washington Apple Health·WA · Dentistry, Oral & Maxillofacial Surgery, Pediatrics +1 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jul 14, 2026
Summary
Effective January 1, 2026, Apple Health (Medicaid) in Washington State now requires prior authorization for frenectomy and frenotomy procedures. Claims submitted without proper prior authorization will be denied. Providers must review billing guides for specific PA criteria and expedited PA eligibility.
Action Required
By December 31, 2025: Billing team must implement prior authorization requirement for frenectomy and frenotomy procedures in the billing system. Update all encounter forms and provider documentation templates to require PA before claim submission. Contact all providers to notify them of this requirement. Review the Washington HCA Dental-Related Services Program Billing Guide and Physician-Related Services/Health Care Professional Services Billing Guide (dated January 1, 2026) for specific PA criteria and expedited PA qualification requirements. Beginning January 1, 2026: Verify prior authorization approval before submitting any frenectomy or frenotomy claims to Apple Health (Medicaid). Do not submit claims for these procedures without documented PA. Failure to obtain prior authorization will result in automatic claim denials per WAC 182-501-0050.